Would you donate to a smoker?

[Yellobelle]

Surgery coming up in a month, and I just found out that my (related) recipient is still smoking. I guess the plan is to go cold-turkey after the transplant? I was surprised, as I thought that you couldn't get on the transplant list without quitting. Other centers seem to at least require smoking cessation programs, since chance of rejection increases if the recipient was a smoker before surgery. I am not sure how to feel about it. I trusted the transplant center to make sure the recipient was a good candidate and I also feel frustrated because my immediate family is sacrificing a lot to make this happen, and why are we the only ones giving things up?

What would you do in this situation?

[Fr Pat]

That's a tough decision, and I don't really know what I would do. A "tough love" approach might be to tell him/her:
"I'm ready to give you my kidney, even though it presents risks and problems for me. But it is a gift I can only give once, so I want to be as sure as possible that the donation will not fail. You will have to take VERY good care of your health after the donation in order not to kill the kidney I am giving you. You will have to faithfully take your anti-rejection meds, watch your diet, go to frequent check-ups. You know that smoking endangers your health seriously. If you won't stop NOW before the surgery, what are the chances that you will stop and take good care of yourself afterwards? If you want me to take the risks involved in giving you my kidney, show me NOW that you are serious about your health by stopping smoking. Otherwise I will have to wait and give my kidney to someone else in the future who will cherish and protect it."
       I'm not really sure I would be able to say that, but it does seem to me to be reasonable. It is love, but a realistic love.
   Fr. Pat

[Yellobelle]

Yeah, sometimes I feel like the least altruistic donor ever. On the one hand, I've always viewed it as a gift, no strings attached. On the other hand, working out the overwhelming logistics of caring for my kids during and post-transplant has highlighted for me that the actual surgery is only a tiny part of my risk and my sacrifice.

I felt like I was in a good place emotionally, this just threw me for a loop, maybe because I had felt that the recipient was the one person who will appreciate my gift (since I feel that the hospital and the recipient's family barely acknowledge what my family is doing). So I am just wondering, is this fair to my nuclear family? Will I feel joy in giving to someone who might not take good care of it? If it doesn't work, will I blame the recipient now?

[Karol]

I would be very surprised if the transplant team condones the smoking. Since the recipient will be immunosuppressed, making illnesses and cancer a bigger risk, it makes no sense to put off quitting.
It's a huge deal, what you're doing, and it must be frustrating not to feel that the recipient is as dedicated to this as you are.

[elephant]

Dear Yellobelle,

Wow that is a difficult decision! 

You are giving a wonderful gift.  I agree that we might want to avoid judging a recipient.  However, this isn't about not approving of the recipients appearance or lifestyle, but a medical concern.  I do not think it's the same thing at all.  If you were donating money to a non-profit, you would want to verify that the money would be used properly.  This is a much more significant donation.

I would request a discussion with the transplant team, to get the best informed opinion about the risks of smoking to the transplant.  For me that would include the transplant physician, the social worker, and my advocate. 

Love, elephant 

[tjhurley]

I do think that kidneys are gifts and gifts shouldn't have strings attached.

If you were giving someone who badly needed a dog, a puppy of yours, you would want to be sure the puppy was going to a safe environment. You want the puppy to have the best chance of growing up. Why shouldn't you give your kidney's new home the same thought process?

It's your responsibility to make sure you feel this is the right choice. Once it's handed over, any actual strings you may want to tie to your gift, just don't exist. You want to have peace of mind in your donation. There just aren't any guarantees. You have to know that you will be okay if the recipient does keep smoking. You can only address your actions and feelings once it's done.

It's okay to not donate your kidney for your own reasons- whatever they may be. It's your kidney. You are donating it to a human. They could do lots of things that will contribute to your kidney's failure. They might feel so great they stop taking their immunos. They might have a playful moment
of liveliness and physically damage it in its new unprotected location. The kidney could fail the first day, week, or month. They might gain weight, keep smoking, get depressed,or any number of things that might make you feel your gift was not appreciated. They already smoke, you know the odds are really high that they will continue. 

You know yourself best. My decision was easy, it was for my son. I was willing to risk all the negatives and was confident I could live with them.  Know yourself and listen to yourself.

I loved that starfish poem about the guy throwing starfish into the ocean, I had once found a group of starfish and had thrown them back into the Gulf. For me, my donation felt like that. You don't know if you are really helping the starfish or not, and you can't see into the future. But for me, I had to try, come what may.

Best of luck to you, Janet
"Class of  January 2009"

[Yellobelle]

Thank you so much for all of your thoughts. The perspectives of fellow donors are very helpful.